The project, with Eduard Vieta, head of the research group and Director of the Institute of Neurosciences at the Hospital Clínic, as the final author, and Vincenzo Oliva, researcher of the same group, as first author, has reviewed 22 systematic reviews with meta-analyses that group together 398 studies on the subject and has analysed the 162 mental health associations summarised in these meta-analyses. To date, the evidence was fragmented across studies relating to specific problems or populations, without any joint analysis to determine which inequalities were backed by the strongest scientific support.
“We not only wanted to compile what has been published, but also to determine to what extent we can trust each of the associations observed," explains Oliva. “This allows us to distinguish inequalities supported by particularly robust evidence from those in which we still need further research.”
The results indicate that being a lesbian, gay, or bisexual adolescent or adult is associated with a two-fold risk of depressive disorders and more than a two-fold risk of suicide attempts compared to heterosexual peers. At the same time, inequalities are not homogeneous within the LGBTQIA+ community; bisexual individuals present greater anxiety symptoms and a higher risk of non-suicidal self-injury than lesbian or gay individuals.
Significant differences also emerge in behaviours related to eating disorders. Among adolescents, gay individuals report dieting and purging behaviours more frequently than heterosexual peers of the same age. Furthermore, body image dissatisfaction shows a consistent gradient based on sex and sexual orientation, with the highest levels observed among heterosexual women, followed by progressively lower levels among lesbian women, gay men, and heterosexual men.
More prevention, early detection and inclusive care
The study highlights the need to develop inclusive prevention and early detection strategies, improve mental health care and address social and structural factors, such as stigma and discrimination, that can contribute to these inequalities.
“In clinical practice, these inequalities must translate into a greater capacity for the early identification of individuals at risk. Knowing the specific vulnerabilities of LGBTQIA+ individuals can help us systematically incorporate them into clinical assessments and better adapt follow-up care and interventions to the needs of each patient,” notes Vieta.
Additionally, knowledge gaps are identified, particularly regarding this community's access to and quality of care, severe mental disorders, and populations from underrepresented geographic contexts. The authors propose that future research be directed towards these areas, as well as implementing longitudinal studies to better understand the mechanisms underlying these inequalities.
Study of reference
Mental health disparities in LGBTQIA+ populations: an umbrella review of systematic reviews and meta-analyses. Vincenzo Oliva et al. World Psychiatry. 2026.
